Is there evidence to support New York's marijuana-opioid law?

Lori Van BurenDr. Eric Schnakenberg, a physician at Community Care Family Medicine in Clifton Park, and his colleague, Julia Gross, a nurse practitioner stand in their facility on Thursday, June 8, 2018 in Clifton Park, N.Y. They are among a small but growing number of practitioners in New York who have found success weaning patients off of opioids and onto medical marijuana for their chronic pain. (Lori Van Buren/Times Union)

Lori Van BurenA sign is seen at the office of Dr. Eric Schnakenberg, a physician at Community Care Family Medicine in Clifton Park, and his colleague, Julia Gross, a nurse practitioner on Thursday, June 8, 2018 in Clifton Park, N.Y. They are among a small but growing number of practitioners in New York who have found success weaning patients off of opioids and onto medical marijuana for their chronic pain. (Lori Van Buren/Times Union)

Paul BuckowskiJohn Coppola, executive director of the New York Association of Alcoholism and Substance Abuse Providers, addresses those gathered for a press conference at the Legislative Office Building Tuesday, March 4, 2014, in Albany, N.Y. Those taking part in the press event called for the state to take actions to combat the growing heroine and prescription drug problem in the state. (Paul Buckowski / Times Union)

Lori Van Buren

Dr. Eric Schnakenberg, a physician at Community Care Family Medicine in Clifton Park, and his colleague, Julia Gross, a nurse practitioner stand in their facility on Thursday, June 8, 2018 in Clifton Park, N.Y. They are among a small but growing number of practitioners in New York who have found success weaning patients off of opioids and onto medical marijuana for their chronic pain. (Lori Van Buren/Times Union)

John Carl D'AnnibaleJohn Coppola, executive director of ASAP speaks at the announcement of a new fundraising initiative led by Jiff-E-Mart of Rensselaer County known as the OSuperStorm Opioids Relief FundO during a news conference Thursday May 31, 2018 in Troy, NY. One cent from every gallon of gas sold through November 2018 will be donated to support addiction awareness and substance abuse prevention, treatment, and recovery services in New York. (John Carl D'Annibale/Times Union)

ALBANY — A coalition of doctors and addiction experts is voicing concern that the state's recent expansion of medical marijuana for the treatment of opioid addiction is not based on evidence and could ultimately harm patients.

While the expansion also authorized marijuana as a replacement for opioids in pain patients, the main concern of these medical and treatment providers centers around its promotion as a treatment for opioid-use disorder. There is no basis in medical science for this, they argue, and worry it promotes the idea that marijuana is as effective as or preferable to established medication-based treatments for opioid addiction, such as buprenorphine, methadone and naltrexone.

"My opinion is that we will see a lot more failures and a lot more relapses among patients who have been in recovery on buprenorphine, naltrexone or methadone who now say, 'Oh, well, now I don't have to take that stuff anymore, I'm going to switch over to marijuana,'" said Dr. Michael Delman, president of the New York Society of Addiction Medicine.

The Medical Society of the State of New York expressed similar sentiments in an Aug. 16 letter to state Health Commissioner Howard Zucker, as did the Alcoholism and Substance Abuse Providers of New York State last week when it urged the state to send a clear message to the public that medical marijuana is not a suitable replacement for more established treatments like those listed above.

"It is critical that funding be dedicated to educate physicians and treatment professionals about this new law as well as the public at large, so that we do not increase the likelihood of relapse and overdose," said John Coppola, executive director of the association. "The public should be able to trust that the treatment made available with state funding is evidence-based and effective. We have no basis to promise either as it relates to the use of marijuana to treat opioid misuse disorders."

Response to epidemic

The state Department of Health on Tuesday defended the new law, enacted this month, which added opioid use disorder to the list of conditions for which health care providers can prescribe medical marijuana in New York. It cited early research suggesting certain formulations of cannabis may be effective at treating opioid use disorder.

"New York state is committed to exploring multiple and diverse options to combat the opioid epidemic, which is damaging so many lives throughout the country," department spokeswoman Jill Montag said. "The Department of Health added opioid replacement and opioid use disorder to the list ... to give practitioners an alternative to prescribing opioids. The department does not advise patients or their health care practitioners regarding the most appropriate treatment option for the patient's condition."

Public health officials have become increasingly desperate to stem the rising tide of deaths from opioids, which have been at epidemic levels nationwide for roughly two decades now and show no signs of slowing. In 2016, more than 3,000 New Yorkers died of opioid overdoses, up from over 1,000 deaths in 2010.

Seeking evidence

Some medical professionals and addiction treatment providers question whether there's really any evidence that marijuana could help curb these deaths.

Several recent studies seemed to reinforce this idea, noting a positive correlation between states with medical marijuana programs and states with lower rates of opioid deaths and prescriptions.

But response to those studies has been divided. Marijuana proponents cite them to support the argument that marijuana is a far safer alternative to opioids for pain treatment. Opponents, however, note the studies are not definitive and caution against drawing conclusions or enacting policy from them.

New York health officials and lawmakers cited these studies as justification for the new law. They also pointed to early research that's come out on the role of cannabis in treating opioid addiction, though few studies have been conducted on humans due to marijuana's classification as a Schedule I drug under federal law.

Among studies that have been performed on humans and animals, researchers noted that an active ingredient in cannabis known as cannabidiol, or CBD, seemed to reduce cravings and anxiety that contributes to heroin-seeking behavior.

Can it hurt?

But more rigorous studies and clinical trials regarding cannabis will be difficult to conduct until federal restrictions on the drug are lifted, researchers say.

To some in the medical and addiction fields, such research must be completed and sufficient evidence provided before states like New York start passing laws that will increase the availability of marijuana. One reason, according to Thomas Madejski, president of the state Medical Society, is that marijuana could worsen underlying psychiatric conditions in opioid-addicted patients.

"MSSNY is concerned that this untested method of treatment will result in patient harm even in certified (treatment) programs," he said.

Another concern is that increasing the availability of an untested drug to a vulnerable population could possibly worsen the drug epidemic, given marijuana's oft-debated status as a "gateway" to harder drugs.

"There's absolutely no scientific evidence that marijuana use is in any way of value in preventing opioid addiction or in treating it," said Delman. "And indeed the current literature shows that people who use marijuana are more likely to use other agents — illicit or otherwise. So that becomes a major problem, especially as it relates to our youth."

Bethany Bump writes about all things health, including state and local health policy, addiction and mental health for the Times Union.

She has previously covered education, business and local governments, and won awards for her coverage of health care and addiction issues.

Bump joined the Times Union in 2015, after a four-year stretch at The Daily Gazette in Schenectady, N.Y.She graduated from Syracuse University's S.I. Newhouse School of Public Communications in 2011, with a bachelor's degree in journalism and political science.